国际呼吸杂志
國際呼吸雜誌
국제호흡잡지
INTERNATIONAL JOURNAL OF RESPIRATION
2009年
19期
1156-1159
,共4页
张文梅%杨敬业%万煜%沈策
張文梅%楊敬業%萬煜%瀋策
장문매%양경업%만욱%침책
围手术期%无创双水平正压通气%慢性阻塞性肺疾病%疗效
圍手術期%無創雙水平正壓通氣%慢性阻塞性肺疾病%療效
위수술기%무창쌍수평정압통기%만성조새성폐질병%료효
Postoperation%Bi-level positive airway pressure%Chronic obstructive pulmonary disease%Treatment Pffeet
目的 探讨围手术期无创双水平正压通气在老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者上腹部手术的治疗效果.方法 将59例中、重度老年缓解期COPD患者随机分为两组,治疗组30例.在常规治疗的基础上加用间歇无创双水平正压通气,术前一周开始使用,术后继续使用(全身麻醉患者于拔管后立即使用)一周.对照组29例.围手术期采用常规抗感染、祛痰、止咳、平喘治疗.结果 治疗组术前动脉血氧分压(PaO2)、第1秒用力呼气容积(FEV1)、呼气峰流速(PEFR)即较入选时明显提高[PaO2:(77.3±4.2)mm Hg vs(86.4±4.7)mm Hg,FEV1:(1.02±0.11)L/s vs(1.37±0.21)L/s,PEFR:(3.47±0.29)L/s vs(4.84±0.34)L/s](P＜0.05).术后两组患者PaO2、PEFR均有不同程度下降,治疗组下降程度明显小于对照组(P＜0.05).治疗组各项指标术后第2天开始恢复,术后第5天恢复至术前水平,对照组各项指标术后第2天开始恢复.术后第7天恢复至术前水平.治疗组肺部并发症发生率明显低于对照组(20%vs 37.9%),治疗组平均住院天数明显短于对照组(9.46 d vs 13.36 d)(P＜0.05).结论 中、重度COPD患者围手术期无创双水平正压通气治疗可以有效地改善患者气流受限的程度,纠正低氧血症,增加通气量,减少术后并发症的产生.
目的 探討圍手術期無創雙水平正壓通氣在老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者上腹部手術的治療效果.方法 將59例中、重度老年緩解期COPD患者隨機分為兩組,治療組30例.在常規治療的基礎上加用間歇無創雙水平正壓通氣,術前一週開始使用,術後繼續使用(全身痳醉患者于拔管後立即使用)一週.對照組29例.圍手術期採用常規抗感染、祛痰、止咳、平喘治療.結果 治療組術前動脈血氧分壓(PaO2)、第1秒用力呼氣容積(FEV1)、呼氣峰流速(PEFR)即較入選時明顯提高[PaO2:(77.3±4.2)mm Hg vs(86.4±4.7)mm Hg,FEV1:(1.02±0.11)L/s vs(1.37±0.21)L/s,PEFR:(3.47±0.29)L/s vs(4.84±0.34)L/s](P＜0.05).術後兩組患者PaO2、PEFR均有不同程度下降,治療組下降程度明顯小于對照組(P＜0.05).治療組各項指標術後第2天開始恢複,術後第5天恢複至術前水平,對照組各項指標術後第2天開始恢複.術後第7天恢複至術前水平.治療組肺部併髮癥髮生率明顯低于對照組(20%vs 37.9%),治療組平均住院天數明顯短于對照組(9.46 d vs 13.36 d)(P＜0.05).結論 中、重度COPD患者圍手術期無創雙水平正壓通氣治療可以有效地改善患者氣流受限的程度,糾正低氧血癥,增加通氣量,減少術後併髮癥的產生.
목적 탐토위수술기무창쌍수평정압통기재노년만성조새성폐질병(chronic obstructive pulmonary disease,COPD)환자상복부수술적치료효과.방법 장59례중、중도노년완해기COPD환자수궤분위량조,치료조30례.재상규치료적기출상가용간헐무창쌍수평정압통기,술전일주개시사용,술후계속사용(전신마취환자우발관후립즉사용)일주.대조조29례.위수술기채용상규항감염、거담、지해、평천치료.결과 치료조술전동맥혈양분압(PaO2)、제1초용력호기용적(FEV1)、호기봉류속(PEFR)즉교입선시명현제고[PaO2:(77.3±4.2)mm Hg vs(86.4±4.7)mm Hg,FEV1:(1.02±0.11)L/s vs(1.37±0.21)L/s,PEFR:(3.47±0.29)L/s vs(4.84±0.34)L/s](P＜0.05).술후량조환자PaO2、PEFR균유불동정도하강,치료조하강정도명현소우대조조(P＜0.05).치료조각항지표술후제2천개시회복,술후제5천회복지술전수평,대조조각항지표술후제2천개시회복.술후제7천회복지술전수평.치료조폐부병발증발생솔명현저우대조조(20%vs 37.9%),치료조평균주원천수명현단우대조조(9.46 d vs 13.36 d)(P＜0.05).결론 중、중도COPD환자위수술기무창쌍수평정압통기치료가이유효지개선환자기류수한적정도,규정저양혈증,증가통기량,감소술후병발증적산생.
Objective To investigate the treatment effects of noninvasive bi-level positive airway Dressure(BiPAP)in elder chronic obstructive pulmonary disease(COPD)patients with upper abdominal surgery in postoperative period.Methods To divide 59 moderate-severe elder stable COPD patients into two groups randomly.Thirty cases in treatment group,intermittent noninvasive BiPAP was added on the basis of general treatment,began to use one week before the surgery and continued to use after the surgery for one week(to use immediately in general anesthesia patients after extubation).Twenty-nine cases in control group,to cure with the general method of removing sputum,relieving caugh and stopping dyspnea in postoperative period.Results PaO2,FEV1,PEFR increased obviously before the surgery in treatment group [PaO2:(77.3±4.2)mm Hg vs(86.4±4.7)mm Hg,FEV1:(1.02±0.11)L/s vs(1.37±0.21)L/s,PEFR:(3.47±0.29)L/s vs(4.84±0.34)L/s](P＜0.05).PaO2,PEFR decreased in varying degrees in both groups after the surgery,and the degree was more obvious in control group than in treatment group (P＜0.05).Parameters began to recover in the second day after the surgery in treatment group,and reached to the normal level in the fifth day,but got tO the normal level in the seventh day in control group.The incidence rate of pulmonary complications was more obvious in control group than in treatment group(20%vs 37.9%),the duration of hospitalization was shorter in treatment group than in control group(9.46 days vs 13.36 days)(P＜0.05).Conclusions The restricted air-flow and hypoxemia can be improved significantly in elder COPD patients with upper abdominal surgery in postoperative period after treatment with nonin-vasive BiPAP increases ventilation,decreases complications after surgery.
